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Email has become one of the more widespread forms of communication. With the advent of secure patient web portals and the understanding that online access could improve care, the medical industry is increasing its use of the tool.

While the effect that email exchanges will have on patients and patient care is not yet known, a study from HMS researchers at Beth Israel Deaconess Medical Center offers some insights into its effects on doctors. According to their data, reimbursement models and physician workflow may need to be adjusted to accommodate message management. The results were published online in October 2014 in Health Affairs.

“Beth Israel was one of the first hospitals in the country to create a web portal through which patients could securely view parts of their medical records and send emails to their clinicians,” says Bradley Crotty ’07, an HMS instructor in medicine at Beth Israel Deaconess, a member of the hospital’s Division of Clinical Informatics, and the paper’s lead author. From 2001 to 2010, nearly 50,000 patients enrolled in the hospital’s patient portal, representing about 23 percent of all patients cared for in the system.

During that decade, the researchers found a nearly threefold increase in email traffic between patients and doctors, but that increase appeared not to be the result of individual patients sending more messages but rather of more patients signing on to the portal.

Although patients didn’t send more messages over time, Crotty found that some doctors exchanged more emails than others did. Primary care doctors, for example, represented only 50 percent of doctors in the system but received 85 percent of the email traffic.

The federal effort to promote the meaningful use of electronic medical records, administered by the Office of the National Coordinator for Health Information Technology, includes incentives to improve use of patient portals. To receive these incentives, medical providers must meet a threshold of exchanging at least one secure email with 5 percent of their patients within a 90-day window.

Meaningful-use literature cites research demonstrating that secure messaging can help patients adhere to treatment plans, which, in turn, can reduce hospital readmission rates. In their discussion, Crotty and colleagues ask how, in a fee-for-service model of care, doctors would be reimbursed for email time. And as health care moves toward managed-care models, in which email exchanges will likely increase, they question how doctors might better incorporate email exchanges into the flow of their busy work days.